Investigation of the Results of Dynamic Stimulation of Accommodation on Patients Receiving Laser Anterior Ciliary Excision Procedure Using Dynamic Aberrometry

AnnMarie Hipsley, Marguerite B. McDonald

Purpose: To investigate and describe the results of LaserACE procedure to restore dynamic accommodation using Hartmann shack (COAS-HD) and dynamic stimulation aberrometry (DSA).

Methods: LaserACE Procedure to restore Natural Dynamic Accommodation was performed on 20patients (40eyes)ages 37-63 during in vivo dynamic accommodation study. Human subjects were measured using a dynamic stimulation aberrometry device ( DSA) attached to a Shack-Hartmann aberrometer (COAS-HD) with a standardized distance and near target. Subjects had measurements taken while viewing the same internal target at increasingly near positions of 3-5D demands until failure.

Results: The objective measurements procedure to analyze aberrations of the ocular systems appears to lead to more accurate results. In the first feasibility study, presbyopic patients measured using the new device showed postoperative Dynamic wavefronts that demonstrated restored accommodative response documented by a 30frame dynamic avi of the wavefronts and PSF. Restored pupil reflexivity with sphere response was also recorded. Significant similarities to young controls were noted in accommodation posture when compared with preoperative exams including pupil reflexivity,wavefront and PSF profiles. Accommodative Amplitudes: MIN=2.28D;MAX=5.5D; MEAN=3.08D; SD=0.0692 (p>0.05).No significant changes in corneal topography or refraction was noted.

Conclusion: Measurement of Dynamic Stimulation of Accommodation after restoration of natural dynamic components with LaserACE appears to be an objective method to measure and study accommodative components and optical conditions pre/post LaserACE procedure. LaserACE procedure shows promise to demonstrate to be the first procedure to rejuvenate the power of the ciliary muscle to restore the requirement of dynamic range of vision of the natural lens and to achieve optical quality and functionality of the eye without compromising the cornea. Analysis of the results show that there may be a rehabilitation component to the procedure and the results may correlate with other individual patient factors such as HA's, manifest refractive error, eye dominance,pre-existing residual accommodative capacity and skill.